长骨骨干增粗的机制及临床意义  

Thickening of the long bone: mechanisms and clinical implications

作　　者：刘振东[1] 周大鹏 秦泗河 Liu Zhen-dong;Zhou Da-peng;Qin Si-he(Department of Orthopedics, No. 230 Hospital of PLA, Dandong 118000,Liaoning Province, China;Department of Traumatic Orthopedics, the General Hospital of Shenyang Military Region of Chinese PLA, Shenyang 110016, Liaoning Province, China;Affiliated Rehabilitation Hospital of National Rehabilitation Aids Center, Beijing 100176, China)

机构地区：[1]丹东市解放军第230医院骨科,辽宁省丹东市118000 [2]解放军沈阳军区陆军总医院创伤骨科,辽宁省沈阳市110016 [3]北京市国家康复辅具中心附属康复医院,北京市100176

出　　处：《中国组织工程研究》2017年第36期5868-5872,共5页Chinese Journal of Tissue Engineering Research

基　　金：全军医药卫生"十五"青年基金资助课题(01Q007)~~

摘　　要：背景:活体骨骼的增粗是重要的自然规律,遗传、营养以及内分泌因素都对骨骼增粗产生重要影响,但这些因素都不具备具体部位的识别能力。目的:分析长骨骨干增粗的机制。方法:临床案例分析结合文献复习。检索中国知网和Medline数据库,英文检索词为Bone Growth in Width,Skeletal thickening,bone thickening,periosteal apposition;中文检索词为骨骼增粗,骨干增粗,外骨膜成骨。检索到相关文献12篇并进行分析探讨。结果与结论:(1)骨骼所承受的力学环境对骨骼的外形塑形发挥着部位特异性的关键作用;(2)长骨骨骼的直径增粗是通过外骨膜成骨来完成的,超负荷引起的应力-血管生成-骨再生的偶联效应是骨骼增粗机制的病理基础。外骨膜成骨和外骨膜骨吸收是一个持续终生的动态过程,弯曲应力是维持外骨膜成骨的最重要因素;(3)如果金属固定材料遮挡了骨骼弯曲应力环境达到一定程度,则可能导致骨骼吸收变细、骨折不愈合等严重后果;(4)临床上要求内固定材料的强度与患者的体质量以及骨骼的粗细相匹配;(5)骨髓腔是天然的低应力区,理论上髓内固定对骨骼的增粗机制影响不大。BACKGROUND:The thickening of living bone is an important natural rule,and genetic,nutritional and endocrine factors play critical roles in the bone thickening;however,these factors are site-blind.OBJECTIVE:To analyze the mechanism underlying the thickening of the long bone.METHODS:Clinical cases and literature were analyzed.Medline and CNKI databases were retrieved using the keywords of“bone growth in width,skeletal thickening,bone thickening,periosteal apposition”in English and Chinese,respectively.Totally12eligible articles were included for result analysis.RESULTS AND CONCLUSION:The mechanical environment of the bone plays a key role in the bone remodeling,which is a site-specific process.The thickening of the long bone is completed through the periosteal apposition,and the coupling effect of stress-angiogenesis-osteogenesis induced by overloading is the pathological basis of bone thickening.The periosteal apposition and periosteal resorption belong to a lifelong dynamic process,and the bending stress is the most important factor to maintain the periosteal osteogenesis.If the bone is shielded from bending stress to a certain extent by the metal fixators,it may lead to bone resorption and thinning,nonunion and other serious consequences.Therefore,the strength of the fixators should match the patient body mass and the thickness of the bone.The marrow cavity is a natural low stress region,so intramedullary fixation theoretically has little effect on the width growth of bone.

关 键 词：组织构建 骨组织工程 骨骼增粗 外骨膜成骨 外骨膜骨吸收 

分 类 号：R318[医药卫生—生物医学工程]